Jaw Pain and Rheumatoid Arthritis

The temporomandibular joint (TMJ) encompassing the jaw is one of the most complex and misunderstood joints in the body.1 There are multiple muscles, bones and soft tissues involved in motions that occur in all directions. The jaw gets used for many purposes all day long – biting, chewing, swallowing, speaking, showing emotions, yawning, etc. Some people grind their teeth at night, called bruxism, putting more stress on the jaw and teeth.2 The National Institute of Dental and Craniofacial Research provides relevant patient information on the TMJ and associated disorders at their comprehensive website.

The problems associated with the TMJ are called temporomandibular disorders (TMD). Symptoms include radiating pain, jaw stiffness, joint locking, and changes in the way teeth fit together.3 TMD can arise from muscle issues called myofascial pain, misalignment of the joint, arthritis of the joint, trauma, or a combination of the above. While many people believe that clicking of the TMJ is a cause, there is no scientific evidence that clicking alone causes disorders. For reasons unknown and like RA, issues with the TMJ are more common with women.4 While no definitive connection has been made, the trigeminal nerve serving much of the head passes very near the joint and may be involved in symptoms.5 A large proportion of people with TMD symptoms also display indications of other medical conditions including chronic headaches/migraines, fibromyalgia, irritable bowel syndrome, and ear ringing.6

Many rheumatoid arthritis patients display TMD. One study showed that upwards of 90% of RA patients showed TMD symptoms.7 The jaw joint can be impacted by rheumatoid arthritis much like it impacts other joints in the body with inflammation, bone erosion, and tissue damage.8 Joint damage in the hands of RA patients was seen as a strong predictor of TMD severity. Other studies show that bone loss in the jaw was related to disease duration and inflammatory blood marker levels.9 Even juvenile idiopathic arthritis (JIA) patients show TMD problems.10

Unfortunately, there is no officially accepted medical specialty or accepted standards of care for TMD. According the non-profit TMJ Association, treatments may include eating soft foods, ice and heat packs, pain medications, exercises, relaxation, side sleeping, avoiding chewing gum, dental splints, and limited cortisone injections. They highly recommend avoiding treatments that cause permanent changes in the jaw or bite. Surgery is not recommended because of lack of scientific evidence.11

Because of the lack of officially accepted practices and research-based treatment options, a myriad of ineffective treatment options are proposed. The Internet only exacerbates the promulgation of hoaxes, moneymaking schemes, and “breakthrough treatments that work in only 3 weeks.” A simple search reveals “FDA” approved devices, videos on how to “permanently cure TMJ”, physical manipulations of the joint, herbal remedies, orthodontic treatments, books galore, and diets for curing TMD. Some people advertise that they can stop TMD headaches forever. Interestedly, many of these untested treatments originate from professional healthcare providers.

Personally, I’ve tried just about everything including ice packs, heat packs, relaxation techniques, physical therapy exercises, self-massage, pharmaceutical muscle relaxants, nighttime dental appliances from cheap drug store ones to professional dentist made models, and botox injections into the associated muscles. All have helped to some extent and the symptoms seem to come and go. One evident pattern is that symptoms appear to become worse during a RA flare or when a RA treatment combination starts loosing effectiveness. But that pattern applies to just about every joint.

Unfortunately, not much is known about the causes and treatments of TMD and more research is needed. It stands to reason that if overall RA symptoms are being controlled by treatment, that TMJ issues will be less likely. It is important to remember that not all TMD symptoms are caused by RA and not all RA patients will get TMD. If you suspect TMD, speak to your rheumatologist and it may also be wise to bring your dentist into the conversation.

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Comments

My RA actually seems to have started with TMJ pain – two years prior to any other joint pain. I went to a few specialists, they found nothing wrong and just attributed it to stress. But the fact that my symptoms:fatigue and TMJ pain- which I didn’t know were symptoms at the time – had started 3-4 years before the RA really kicked in helped me realise that in wasn’t my fault, that I didn’t cause my RA by worrying too much, eating fast food or anything like that and also that I had to accept my fate and couldn’t change anything, bacsue the process had started a long time ago. That the RA had been brewing in me for a while, probably was gonna come out anyway and just got triggered by overworking my wrists and fingers at work by typing. Typing gave me RA. Now that’s a headline.
P.S. Haven’t had a pain-free jaw for 3-4 years. I have to even watch how I yawn because I’m afraid my jaw will lock or come off the joint (my worst nightmare). And then there are the headaches, which are almost an everyday occurence.
What I’ve realized through all of this is that if something hurts, your body’s trying to tell you something, and you should listen and get to the bottom of it. I ignored my RA symptoms to the point I couldn’t put my pants on or sleep through the night, but weirdly though nothing of all that stiffness and pain. Denial, I guess.
Anyway, thank you so much for the article, very important information for everyone!

I found your article with relief. I have over a few years, had discomfort, presumed it was my back teeth. I would go to the dentist. No problem, was I grinding my teeth in my sleep? Just lately, same thing, one side eased with an increase in anti inflammatories and pain relief for a couple of days. Now it’s on the other side but i now know why. Started muesli and have gone back to porridge. muesli requires too much chewing. So I may have set it off, who knows. If I don’t sleep well, it seems worse. Most likely clenching my teeth.
I have been diagnosed with rheumatoid at least 19 years ago, its amazingly annoying to say the least that it flips about, regardless of what I do right.

I am finding a lot of your posts relate to me! I have had TMJ since I was a preteen. I also have an odd symptom that I mention to doctors and dental practitioners, but haven’t had much of a response about: I get pain right in front of my TMJ joint when eating tart or sour foods or drink wine. It’s random, but when it happens it really hurts! Recently I have wondered if this could be caused by sjogrens or even a prior post of yours I commented on referring to pain in the neck and subluxations.

I am in the process of getting insurance approval for botox for my chronic migraines and torticollis, but maybe I will mention my TMJ to them. My jaw literally pops every time I open my mouth. I have an overbite and have had a few doctors tell me braces (again!) would help fix my overbite and correct my TMJ.

I get botox every 3 months for migraines from a board certified neurologist. Most of the injections are in the temple, forehead, down the neck and sometimes in shoulders. When I mentioned that I was having jaw problems, he put a few into the masseter muscle (cheek) and near the joint. It does reduce the pain there. For insurance purposes, you have to be diagnosed for some FDA approved purpose for botox which are listed below. It took quite a while, a lot of debilitating migraines, and multiple treatments that didn’t work, to get diagnosed with chronic migraines and to get botox. It has helped reduce the severity and number of migraines.